A case of vertical nystagmus directed downward is reported with reference to the literature including MLF syndrome.
Case:
A 5D-years-old taximan visited to our clinic in March, 1969, with C. C, of diplopia, which developed suddenly at the night on October 15th, 1968, when he was watching TV with side down position. He had been treated by several doctors but the symptom did'nt clear up, He was admitted to the 2nd Tokyo National Hospital on March 14th, 1969.
Physical examination on admission revealed a well developed well nourished male patient who was alert and cooperative. The blood pressure was 124/82mmHg. The significant neurological findings revealed bilateral ptosis, weakness of lateral gaze on the right, oscillopsia and positive Babinski's sign, Convergence was well preserved, There was no hearing-loss. The equilibrium test revealed no abnormal findings except dissociated nystagmus, i. e.: on direct forward gaze, both eyes had no nystagmus. On attempting conjugate lateral gaze at first horizontal nystagmus was seen, then after ca 15 sec, this horizontal component gradually disappeared but vertical component (downward) became evident in both abducting eyes, whereas in the case of adduction the vertical nystagmus was seen and did'nt change. The nystagmus were recorded by electronystagmography. The optokinetic nystagmus was elicited in both horizontal and vertical directions by projecting a black-white striped pattern rotating from 0°/sec. to 120°/sec. on a halfcylinder screen that nearly fills the visual fields. Optokinetic inversion occured in the horizontal plane. When the optokinetic stimulus directed downward was used, elicited vertical nystagmus was diminished in its degree.
One year after the onset of his illness diplopia cleared up with full ocular movement and vertical nystagmus diminished much.
According to his history both medial rectus palsy was suspected at the onset of illness. We presumed this case was an incomplete type of MLF syndro me due to a vascular lesion in the brain stem.
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